Long-Term Care, Home Health & Hospice

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Update to Revalidation Enrollment Procedures

Posted on August 11, 2011 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

As an update to the previous post on the revalidation enrollment procedures it is important for hospices, home health agencies, and DMEPOS to know what level of screening they will receive from the Medicare Administrative Contractor (“MAC”).  In some instances these providers and suppliers will be screened at either a “high” or “moderate” level of risk by the MAC.  The risk category assigned corresponds with the amount of possible fraud and abuse that CMS believes is applicable to providers and suppliers.

All hospices (current and newly enrolled) will be screened at a “moderate” level of risk.  Newly enrolling home health agencies will be screened at a “high” level of risk.  The only other “high” category is newly enrolling DMEPOS.  DMEPOS or home health agencies that are publicly traded on the NYSE or NASDAQ are classified as “limited” risk.   Currently enrolled home health agencies and DMEPOS will be screened at a “moderate” level of risk.

It is VERY important that currently and newly enrolled hospices, home health agencies and DMEPOS accurately complete the revalidation process when completing the applicable CMS Form 855 due to the level of screening it will receive from the MAC.  It is also VERY important to know that the CMS Form 855 has recently changed and requires, in some instances, much more detailed information.  For example, the providers are required to provide much more detail on its ownership and operating structure.

Should you have questions on the revalidation process or the new CMS Form 855, please contact Todd Selby at 317.977.1440 or, Brian Jent at 317.977.1402 or, David Bufford at 502.568.9368 or, or your regular Hall Render attorney.